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1.
BMJ Open ; 2(6)2012.
Artigo em Inglês | MEDLINE | ID: mdl-23117566

RESUMO

OBJECTIVE: Rural north-central Liberia has one of the world's highest maternal mortality ratios. We studied health facility birthing service utilisation and the motives of women seeking or not seeking facility-based care in north-central Liberia. DESIGN: Cross-sectional community-based structured interviews and health facility medical record review. SETTING: A regional hospital and the surrounding communities in rural north-central Liberia. PARTICIPANTS: A convenience sample of 307 women between 15 and 49 years participated in structured interviews. 1031 deliveries performed in the regional hospital were included in the record review. PRIMARY OUTCOMES: Delivery within a health facility and caesarean delivery rates were used as indicators of direct utilisation of care and as markers of availability of maternal health services. RESULTS: Of 280 interview respondents with a prior childbirth, only 47 (16.8%) delivered their last child in a health facility. Women who did not use formal services cited cost, sudden labour and family tradition or religion as their principal reasons for home delivery. At the regional hospital, the caesarean delivery rate was 35.5%. CONCLUSIONS: There is an enormous unmet need for maternal health services in north-central Liberia. Greater outreach and referral services as well as community-based education among women, family members and traditional midwives are vital to improve the timely utilisation of care.

2.
Int J Gynaecol Obstet ; 116(1): 64-6, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22036509

RESUMO

OBJECTIVE: To characterize colorectal symptoms in women with a history of an obstetric vesicovaginal fistula (VVF). METHODS: Patients under evaluation with a VVF during two 2-week surgical service trips to Evangel Hospital VVF Center in Jos, Nigeria, in 2010 were assessed for symptoms of fecal incontinence (FI) using the Vaizey and Colorectal-Anal Impact (CRAIQ) questionnaires. Women with rectovaginal fistulas were excluded. Each participant's impression of overall health was assessed using a visual analog scale (VAS) from 0 (poor) to 15 (excellent). A study nurse translated questionnaires into native languages. RESULTS: The mean age of the 83 women included was 29 years. Three women (3.6%) reported FI and 42 (50.6%) reported constipation. All of the women with FI reported that it affected their quality of life on the CRAIQ. Average VAS score was 10.8 overall and 6.8 for women with FI. CONCLUSION: In this population of women with VVF but no rectovaginal fistulas, we found a low prevalence of fecal incontinence and a high prevalence of constipation. Despite significant pelvic floor trauma resulting in VVF, the majority of patients appeared to have an intact bowel continence mechanism.


Assuntos
Parto Obstétrico/efeitos adversos , Fístula Vesicovaginal/epidemiologia , Adolescente , Adulto , Constipação Intestinal/epidemiologia , Constipação Intestinal/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Nigéria/epidemiologia , Medição da Dor , Prevalência , Qualidade de Vida , Inquéritos e Questionários , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia , Fístula Vesicovaginal/etiologia , Adulto Jovem
3.
Br J Med Surg Urol ; 4(6): 259-265, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22229049

RESUMO

OBJECTIVES: To assess factors influencing short-term outcomes of vesicovaginal fistula (VVF) repairs in community-dwelling women of Liberia, Africa. METHODS: Forty patients who underwent VVF repairs were analyzed. Primary outcome was continence status at 14 days post repair. Factors influencing continence status were characterized. RESULTS: The mean duration of leakage was 9.6 ± 8.3 years, (3 months-28 years). Thirteen (33%) had previous repairs, and 6 (15%) had multiple fistula sites. Twenty-eight (70%) were continent at catheter removal. First time repairs had a higher continence rate compared to women with previous repairs, 78% and 54% respectively (p= 0.15). Seven (47%) juxtaurethral repairs were considered failures, while only one (9%) juxtacervical fistulas remained incontinent (p= 0.069). Controlling for duration of leakage, women with previous repairs were significantly less likely to be continent (p = 0.04; adjusted OR = 0.07; 95% CI: 0.005, 0.83). CONCLUSIONS: Patients with previous VVF repairs and juxtaurethral fistulae experience lower success rates; surgery remains an effective treatment for many VVF patients.

5.
Cancer ; 116(10): 2322-31, 2010 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-20225230

RESUMO

BACKGROUND: Testicular cancer is curable in the majority of men, and persisting treatment toxicity is a concern. The authors report a cross-sectional study of the long-term effects of chemotherapy (C) on neurologic function and development of Raynaud phenomenon. METHODS: Seven hundred thirty-nine patients who were treated between 1982 and 1992 gave consent to enter the study. Patients were classified according to the receipt of C (n = 384) or no C (n = 355). Patients completed a general health questionnaire and a quality-of-life form (the European Organization for Research and Treatment of Cancer Quality-of-Life C30 questionnaire with testicular module). Symptom scores of 3 or 4 were considered clinically significant. Patients were assessed in the clinic, and clinical history was used to diagnose Raynaud phenomenon (RP) and tinnitus. Examinations included peripheral nerve function testing for light touch and vibration sense. Five hundred seventy-seven patients underwent audiometry. RESULTS: On physician assessment, peripheral neuropathy and RP were more common after C (21.7% vs 9.1% [P<.001] and 20.3% vs 1.7% [P<.001], respectively). Similar results were obtained for symptom scores (12.5% vs 5.5% [P = .002] and 9.7% vs 3.7% [P<.001], respectively). On multivariate analysis, for peripheral neuropathy, the significant predictors were cisplatin dose, carboplatin dose, and age. For RP, the significant predictor was bleomycin. Significant differences in hearing thresholds were noted at 8000 hertz only and, on multivariate analysis, were related to age, cisplatin dose, and vincristine dose. Auditory symptom scores did not differ between groups. CONCLUSIONS: With long-term follow-up, peripheral neuropathy and RP remained detectable in approximately 20% of patients and caused significant symptoms in 10% of patients. Detectable effects on high frequency remained but caused little symptomatic problem. These effects persisted and were related to the cumulative chemotherapy dose.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doença de Raynaud/induzido quimicamente , Neoplasias Testiculares/tratamento farmacológico , Adolescente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Perda Auditiva/induzido quimicamente , Humanos , Masculino , Microcirculação/efeitos dos fármacos , Pessoa de Meia-Idade , Tempo , Zumbido/induzido quimicamente
7.
J Clin Oncol ; 27(13): 2144-50, 2009 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-19307514

RESUMO

PURPOSE: To identify predictive factors of adherence to medical advice, specifically the likelihood of attendance to a recommended follow-up regimen in patients with newly diagnosed testicular cancer. PATIENTS AND METHODS; This was a prospective study measuring initially not only aspects of the doctor-patient interview, but also a range of demographic, psychological, social, and medical factors, and then recording attendance behavior on follow-up. All 209 new patients with testicular cancer referred between June 1992 and May 1995 were approached, and 184 men consented and completed questionnaires. The nonadherence end point (nonattender) was two failures to attend an outpatient appointment at least 1 month apart, despite a written reminder. RESULTS: Thirty-two participants (17%) were classified as nonattenders. No significant differences were found between attenders and nonattenders in the majority of psychosocial and medical variables that might have predicted nonadherence to medical advice. There was a highly significant association between nonattendance and a patient's perception of an unsatisfactory affective relationship with his clinician (P = .005; hazard ratio, 3.1; 95% CI, 1.4 to 6.6). CONCLUSION: Patients who perceived an unsatisfactory affective relationship with their clinician that included an inability to trust the clinician and a perception that they were not being treated as "a person" were subsequently more likely to disregard medical advice regarding follow-up. Attention to the ways young men may wish to communicate with their clinicians is important, bearing in mind that they may not necessarily adhere to stereotypical images of masculine self-dependence.


Assuntos
Cooperação do Paciente , Relações Médico-Paciente , Neoplasias Testiculares/terapia , Adulto , Afeto , Humanos , Masculino , Estudos Prospectivos , Inquéritos e Questionários , Neoplasias Testiculares/psicologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-18810301

RESUMO

This paper presents a pilot study exploring the utility and feasibility of use of a vesicovaginal fistula (VVF) patient educational brochure. Women awaiting or recently having undergone VVF surgery examined a six-paneled educational brochure detailing the causes, treatment options, and prevention methods of VVF. Participants answered demographic questions and gave detailed responses to a questionnaire that addressed the brochure material. A convenience sample of 50 patients, with a mean age of 26.1 years, participated. Universally, these women felt that the information they learned from the brochure was useful. Suggestions by participants regarding prevention of VVF included laboring in a hospital (80%), educating other women (30%), and discouraging early marriage (8%). Primary barriers to prevention and treatment included financial restraints (84%) and transportation difficulties (30%). The utilization of a simple, low-cost educational brochure has the ability to educate women on the causes, treatment, and prevention of VVF.


Assuntos
Hospitais Especializados , Folhetos , Educação de Pacientes como Assunto/métodos , Fístula Vesicovaginal , Adolescente , Adulto , Análise Custo-Benefício , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Nigéria , Educação de Pacientes como Assunto/economia , Projetos Piloto , Inquéritos e Questionários , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/prevenção & controle , Fístula Vesicovaginal/cirurgia , Adulto Jovem
9.
BJU Int ; 103(9): 1256-69, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19040532

RESUMO

OBJECTIVE: To integrate the mapping of ERG alterations with the collection of expression microarray (EMA) data, as previous EMA analyses have failed to consider the genetic heterogeneity and complex patterns of ERG alteration frequently found in cancerous prostates. MATERIALS AND METHODS: We determined genome-wide expression levels with GeneChip Human Exon 1.0 ST arrays (Affymetrix, Santa Clara, CA, USA) using RNA prepared from 35 specimens of prostate cancer from 28 prostates. RESULTS: The expression profiles showed clustering, in unsupervised hierarchical analyses, into two distinct prostate cancer categories, with one group strongly associated with indicators of poor clinical outcome. The two categories are not tightly linked to ERG status. By analysis of the data we identified a subgroup of cancers lacking ERG rearrangements that showed an outlier pattern of SPINK1 mRNA expression. There was a major distinction between ERG rearranged and non-rearranged cancers that involves the levels of expression of genes linked to exposure to beta-oestradiol, and to retinoic acid. CONCLUSIONS: Expression profiling of prostate cancer samples containing single patterns of ERG alterations can provide novel insights into the mechanism of prostate cancer development, and support the view that factors other than ERG status are the major determinants of poor clinical outcome.


Assuntos
Mapeamento Cromossômico/métodos , Perfilação da Expressão Gênica/métodos , Neoplasias da Próstata/genética , Transativadores/genética , Proteínas de Transporte/genética , Humanos , Imuno-Histoquímica , Hibridização in Situ Fluorescente , Masculino , Regulador Transcricional ERG , Inibidor da Tripsina Pancreática de Kazal
10.
Int J Gynaecol Obstet ; 101(1): 35-8, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18083173

RESUMO

OBJECTIVE: To follow-up the quality of life outcomes in 2 women who underwent a modified Mainz II pouch procedure for refractory vesicovaginal fistulas. METHOD: Two Nigerian patients were located after undergoing a modified Mainz II pouch procedure. They were interviewed 1-2 years postprocedure regarding subsequent sexual function, pregnancy outcomes, and daily life. RESULT: After undergoing the procedure the patients had resumed sexual function, had become pregnant, and had delivered viable neonates. They were also able to provide for their families. CONCLUSION: A urinary diversion procedure for management of refractory vesicovaginal fistula can restore quality of life.


Assuntos
Qualidade de Vida , Derivação Urinária/métodos , Fístula Vesicovaginal/cirurgia , Adolescente , Adulto , Feminino , Humanos , Nigéria , Gravidez , Recidiva , Resultado do Tratamento
11.
Clin Med Oncol ; 2: 135-44, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-21892276

RESUMO

PURPOSE: The benefit of neoadjuvant therapy for tumours above the peritoneal reflection is not clear. The purpose of this study is to demonstrate the feasibility and downstaging of treating locally advanced tumours from high rectum to distal sigmoid with preoperative chemoradiotherapy (CRT). METHODS AND MATERIALS: Seventeen patients with high rectal, rectosigmoid or distal sigmoid tumours above the peritoneal reflection received neoadjuvant CRT, selected on MRI findings indicating T4 disease or threatened circumferential resection margin. All patients were administered neoadjuvant chemotherapy, with Oxaliplatin or Mitomycin C and a Fluoropyrimidine. The pelvis received long-course CT-planned conformal RT, 45 Gy in 25 fractions, with a boost of 5.4-9 Gy in 3-5 fractions. Thirteen patients were treated with concomitant oral or intravenous Fluoropyrimidine chemotherapy. RESULTS: Median follow-up was 37 months. Overall survival was 82.35% (95% Confidence Interval (CI) 54.7-93.9) and disease free survival 81.25% (95% CI 52.5-93.5). Only 1 patient suffered loco-regional relapse. Chemotherapy regimens were well tolerated, though some patients required dose reductions. Nine patients (52.9%) lowered pathologic disease AJCC stage, i.e. 'downstaged'. Six patients (35.3%) achieved complete pathological response. Clear margins were attained in all but 1 patient. Three patients were converted from cT4 to ypT3. No patient required a gap during CRT. One patient suffered a grade III acute toxicity, but no grade IV (RTOG). There were 3 grade III and 3 grade IV late toxicities (LENT-SOMA). CONCLUSIONS: Locally advanced high rectal and recto-sigmoid tumours may be treated with pre-operative CRT with acceptable toxicity, impressive down-staging, and clear surgical margins.

12.
Leuk Lymphoma ; 48(3): 547-50, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17454597

RESUMO

Mucosa associated lymphoid tissue (MALT) lymphoma of the lung is a rare disease with an indolent clinical behaviour. This single centre retrospective analysis evaluates the treatment strategies and clinical outcome for these patients. A total number of ten patients (7 male/3 female) were identified between January 1997 and October 2005 and their records analysed. At diagnosis the patients presented with unspecific symptoms (cough, shortness of breath and lower respiratory chest infection) which were further evaluated. Six patients had stage IAE disease, two patients stage IIAE and in two patients disease was stage IV. The initial treatment consisted of surgery alone (3 patients), chemotherapy +/- rituximab (5/1 patients), single agent rituximab (1 patient) and wait & watch strategy (1 patient). After a median follow-up time of 3.4 years the overall survival was 90% at 3 years. In conclusion, our data suggest that most of the patients with MALT of the lung had localized disease which generally responded well to systemic or local therapy and resulted in favourable long-term outcome underlining the indolent course of this disease.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Pulmonares/terapia , Linfoma de Zona Marginal Tipo Células B/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Murinos , Clorambucila/administração & dosagem , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/cirurgia , Linfoma de Zona Marginal Tipo Células B/tratamento farmacológico , Linfoma de Zona Marginal Tipo Células B/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Rituximab , Resultado do Tratamento , Vidarabina/administração & dosagem , Vidarabina/análogos & derivados
13.
Hematology ; 12(2): 149-53, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17454196

RESUMO

This is the first report of the combination of gemcitabine, cisplatin and methylprednisolone (GEM-P) with Rituximab (GEM-PR) for diffuse large B-cell lymphoma (DLBCL). Thirty-nine patients with relapsed or refractory DLBCL in this study received GEM-P with (n = 24) or without Rituximab (n = 15) 64% patients had Stage III/IV disease. The overall response rate (ORR) was 59% (95% CI 42.1-74.4); 11/39 (28%) patients attained complete response. Patients received a median of two cycles (1-4) of treatment. For GEM-PR group, the ORR was 67% (95% CI 45-84%) compared to 47% (95% CI 21-73%) in GEM-P alone. one-year progression-free survival was 51% (95% CI 28-69%) in GEM-PR group compared to 27% (95% CI 8-49%) in GEM-P alone (P = 0.04). GEM-P is an effective second-line regimen in patients with relapsed or refractory DLBCL and the addition of Rituximab appears to further improve outcomes.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Imunoterapia , Linfoma Difuso de Grandes Células B/terapia , Terapia de Salvação , Adolescente , Adulto , Idoso , Anticorpos Monoclonais Murinos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Terapia Combinada , Desoxicitidina/administração & dosagem , Desoxicitidina/efeitos adversos , Desoxicitidina/análogos & derivados , Intervalo Livre de Doença , Avaliação de Medicamentos , Feminino , Humanos , Estimativa de Kaplan-Meier , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/radioterapia , Linfoma Difuso de Grandes Células B/cirurgia , Masculino , Metilprednisolona/administração & dosagem , Metilprednisolona/efeitos adversos , Pessoa de Meia-Idade , Transplante de Células-Tronco de Sangue Periférico , Radioterapia Adjuvante , Indução de Remissão , Estudos Retrospectivos , Rituximab , Análise de Sobrevida , Taxa de Sobrevida , Resultado do Tratamento , Gencitabina
14.
Haematologica ; 92(2): 271-2, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17296587

RESUMO

Novel, effective therapies are needed for peripheral T-cell non-Hodgkin's lymphoma (PTCL). We treated 16 patients with a combination of gemcitabine, cisplatin and methylprednisolone (GEM-P). Three patients (19%) achieved a complete remission and eight (50%) a partial remission. GEM-P has encouraging efficacy with an acceptable toxicity profile in patients with PTCL.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cisplatino/administração & dosagem , Desoxicitidina/análogos & derivados , Linfoma de Células T Periférico/tratamento farmacológico , Metilprednisolona/administração & dosagem , Adolescente , Adulto , Idoso , Desoxicitidina/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Indução de Remissão , Resultado do Tratamento , Gencitabina
15.
Int Urogynecol J Pelvic Floor Dysfunct ; 18(5): 485-91, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17160530

RESUMO

Significant obstetric-related pelvic floor injury is still all too common in many areas of the world. Vesicovaginal fistula formation typically results from obstructed labor in the setting of limited medical resources for the patient. Many people have dedicated their time and even their lives to repairing these types of pelvic floor injuries, which certainly can impact in a positive way on the quality of life of these suffering women. However, it is time to consistently combine surgical repair initiatives with education, training, and prevention strategies, as well as outcomes research in order to improve on these efforts. It is only through committed initiatives with all of these elements that we may be able to ultimately decrease the prevalence of these types of pelvic floor sequelae.


Assuntos
Fístula Vesicovaginal/prevenção & controle , África , Redes Comunitárias , Cultura , Atenção à Saúde , Países em Desenvolvimento , Escolaridade , Feminino , Ginecologia/educação , Educação em Saúde , Planejamento em Saúde , Hospitais de Distrito/organização & administração , Humanos , Medicina Tradicional , Complicações do Trabalho de Parto , Obstetrícia/educação , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Qualidade de Vida , Religião e Medicina , Fatores Socioeconômicos , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/cirurgia
16.
Int J Radiat Oncol Biol Phys ; 65(2): 445-51, 2006 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-16690432

RESUMO

PURPOSE: Neoadjuvant therapy is traditionally reserved for locally advanced mid and low rectal cancers. In tumors above this level, the need for adjuvant treatment is based on poor histopathologic features, but this approach has potential disadvantages. The aim of this study was to determine whether magnetic resonance imaging (MRI) could accurately stage tumors of the distal sigmoid, rectosigmoid, and upper rectum and help direct preoperative treatment. MATERIALS AND METHODS: A total of 75 patients with distal sigmoid, rectosigmoid, and upper rectal tumors were assessed preoperatively by MRI. If tumor extended beyond the planned surgical resection plane, chemoradiotherapy was offered. RESULTS: Of the 75 patients, 57 (76%) underwent primary surgery. Agreement between the MRI prognosis and histopathologic findings was 84% (95% confidence interval [CI], 72.6-92.7%). The other 18 patients underwent neoadjuvant chemoradiotherapy for poor prognostic features with predicted surgical resection margin involvement. The histopathologic examination confirmed tumor downstaging in 9 of the 18 patients who underwent chemoradiotherapy. The 3-year survival rate in the good prognosis group (91%; 95% CI, 77.1-97.3%) was not significantly different from that of the chemoradiotherapy group (81.4%; 95% CI, 52.4-93.6%). The poor prognosis group undergoing primary surgery had significantly worse survival (62.2%; 95% CI, 30.3-82.8%, p < 0.03). CONCLUSION: Our findings indicate that tumors of the distal sigmoid, rectosigmoid, and upper rectum can be staged accurately using high spatial resolution MRI and that those with poor prognostic disease may benefit from preoperative therapy.


Assuntos
Imageamento por Ressonância Magnética , Estadiamento de Neoplasias/métodos , Neoplasias Retais , Neoplasias do Colo Sigmoide , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Combinada/métodos , Feminino , Fluoruracila/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Mitomicina/administração & dosagem , Prognóstico , Dosagem Radioterapêutica , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/patologia , Neoplasias Retais/radioterapia , Neoplasias Retais/cirurgia , Estudos Retrospectivos , Neoplasias do Colo Sigmoide/tratamento farmacológico , Neoplasias do Colo Sigmoide/patologia , Neoplasias do Colo Sigmoide/radioterapia , Neoplasias do Colo Sigmoide/cirurgia , Taxa de Sobrevida
17.
Artigo em Inglês | MEDLINE | ID: mdl-15789144

RESUMO

The purpose of this prospective study was to describe the effects of the tension-free vaginal tape (TVT) procedure on subjective and objective outcomes. Eighty-seven women (aged 31-95 years) underwent a TVT procedure and were followed for up to 24 months using the Incontinence Impact Questionnaire (IIQ-7), Urogenital Distress Inventory (UDI-6), and a Patient Satisfaction Questionnaire. IIQ-7 scores improved from a mean 51.1 before surgery to 12.7 at 1 month (p<0.001) indicating reduced impact of incontinence on quality of life. UDI-6 scores declined from a mean 61.8 to 21.9 (p<0.001) indicating improvement in urinary symptoms. At 1 month, 91.2% of patients were satisfied. Improvements on all measures were maintained throughout follow-up. Urodynamic evaluation of 57 patients (mean: 15.0 months) showed that 91.2% had a negative stress test. Results indicate significant immediate and sustained improvement in incontinence impact and urinary symptoms, and a high rate of patient satisfaction and objective cure.


Assuntos
Qualidade de Vida , Estresse Psicológico/etiologia , Telas Cirúrgicas , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/instrumentação , Vagina/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária por Estresse/psicologia , Urodinâmica
18.
J Clin Oncol ; 22(12): 2395-403, 2004 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-15197201

RESUMO

PURPOSE: To identify baseline prognostic factors and assess whether pretreatment quality of life (QoL) predicts survival in patients with locally advanced or metastatic esophago-gastric cancer. PATIENTS AND METHODS: Between 1992 and 2001, 1,080 patients were enrolled into three randomized, controlled trials assessing fluorouracil-based combination chemotherapy. All patients were required to complete the European Organization for Research and Treatment of Cancer core QoL questionnaire before random assignment. RESULTS: Of the 1080 patients randomly assigned, 979 (91%) died. Four independent poor prognostic factors were identified by multivariate analysis: performance status >or= 2 (hazard ratio [HR], 1.58; 99% CI, 1.25 to 1.98), liver metastases (HR, 1.41; 99%CI, 1.14 to 1.74), peritoneal metastases (HR, 1.33; 99%CI, 1.01 to 1.74) and alkaline phosphatase >or= 100 U/L (HR, 1.41; 99% CI, 1.14 to 1.76). A prognostic index was constructed dividing patients into good (no risk factor), moderate (one or two risk factors) or poor (three or four risk factors) risk groups. One-year survival for good, moderate, and poor risk groups were 48.5%, 25.7%, and 11%, respectively, and the survival differences among these groups were highly significant (P <.00001). Compared with the good risk group, the moderate risk group had nearly twice the risk of death, and the poor risk group had 3.5-fold increased risk of death. Pretreatment physical (P =.003), role functioning (P <.001), and global QoL (P <.001) predicted survival. CONCLUSION: Four poor prognostic factors were identified and a simple prognostic index was devised. Information from this analysis can be used to aid clinical decision-making, help individual patient risk stratification, and serve as benchmark for the planning for future phase III trials.


Assuntos
Neoplasias Esofágicas/diagnóstico , Qualidade de Vida , Neoplasias Gástricas/diagnóstico , Adulto , Idoso , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Análise Multivariada , Metástase Neoplásica , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Gástricas/mortalidade , Análise de Sobrevida , Taxa de Sobrevida
19.
Clin Colorectal Cancer ; 3(4): 235-42, 2004 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15025796

RESUMO

The combination of protracted venous infusion (PVI) fluorouracil (5-FU) and mitomycin-C has previously been shown to be superior to PVI 5-FU alone in terms of response rate and failure-free survival. This study explores the effect of dose intensification by circadian timing of 5-FU in this combination on response, toxicity, and survival. Patients with advanced colorectal carcinoma were randomized to receive PVI 5-FU 300 mg/m2 daily or circadian-timed infusion (CTI) of 5-FU, beginning at 600 mg/m2 and subsequently reduced to 450 mg/m2, delivered as a flat-rate infusion from 10:15 PM to 9:45 AM. Both groups received mitomycin-C at a dose of 7 mg/m2 given every 6 weeks. From April 1996 to August 1998, 320 patients were randomized, including 263 with metastatic disease and 21 with circumferential margin involvement. The overall response rate for the PVI 5-FU group was 38%, compared with 30.3% for the CTI group (P = 0.176). There was no statistically significant difference in terms of failure-free survival (8.0 months vs. 9.9 months; P = 0.131) or overall survival (15.8 months vs. 16.3 months; P = 0.275) between the treatment groups. There were no differences in global quality of life. Grade 3/4 diarrhea occurred significantly more frequently with CTI 5-FU (6.5% vs. 19.8%; P < 0.001); a nonsignificant trend toward increased incidences of grade 3/4 infection and palmar plantar erythema were observed with CTI 5-FU. This study confirms the high response rate and overall survival figures for the combination of PVI 5-FU and mitomycin-C in colorectal cancer. However, dose intensification of 5-FU using a circadian-timed, flat-rate infusion did not lead to improved response or survival.


Assuntos
Adenocarcinoma/tratamento farmacológico , Antineoplásicos/administração & dosagem , Neoplasias Colorretais/tratamento farmacológico , Fluoruracila/administração & dosagem , Mitomicina/administração & dosagem , Ritmo Circadiano , Humanos , Infusões Intravenosas , Análise de Sobrevida , Resultado do Tratamento
20.
Int J Radiat Oncol Biol Phys ; 58(1): 53-8, 2004 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-14697420

RESUMO

PURPOSE: Serum hemoglobin level (Hb) is a significant determinant of treatment outcome after radical radiotherapy (RT) for several cancer types, but its importance in prostate cancer is not well established. METHODS AND MATERIALS: Two treatment-specific cohorts of men with localized prostate cancer (T1-4, Nx/N0, M0) were analyzed. Seven hundred six men who received radical RT at Princess Margaret Hospital between 1987 and 2000 comprise the RT-alone cohort, of whom 536 had a pre-RT Hb. Six hundred fifty-eight men received 3-6 months' neoadjuvant androgen deprivation (NAD) and radical RT at Royal Marsden Hospital between 1989 and 2000 and comprise the NAD + RT cohort, of whom 475 had a pre-NAD Hb and 513 a pre-RT Hb. Time to biochemical failure (TTBF) was the primary end point. Univariate and multivariate analyses using the Cox proportional hazards regression model were used for each data set independently to study the prognostic role of pre-RT Hb, pre-NAD Hb, nadir Hb (lowest Hb during RT), Hb decrement (pre-NAD Hb - pre-RT Hb), Gleason score, presenting PSA, and T stage. RESULTS: On univariate analysis, no significant association was seen between TTBF and any of the Hb variables for either data set. On multivariate analysis, TTBF was associated with presenting PSA (p < 0.001), Gleason score (p < 0.01), and (for the NAD + RT data set) T stage (p < 0.001), but not pre-NAD Hb (p = 0.24) or pre-RT Hb (p > 0.3). CONCLUSION: Hemoglobin level is not an important determinant of RT outcome in localized prostate cancer.


Assuntos
Antagonistas de Androgênios/uso terapêutico , Antineoplásicos Hormonais/uso terapêutico , Hemoglobina A/metabolismo , Neoplasias da Próstata/sangue , Neoplasias da Próstata/terapia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos de Coortes , Terapia Combinada , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/patologia , Neoplasias da Próstata/radioterapia , Fatores de Tempo , Resultado do Tratamento
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